| NPI | 1891788667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME130249) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 216925) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2019-12-16 |